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Metrics and Scoring Committee begins identifying quality measures


Metrics and Scoring Committee begins identifying quality measures

The newly formed nine-member Metrics and Scoring Committee held its second committee meeting this week. The committee will set the metrics to help measure the health of people served by Coordinated Care Organizations (CCOs).

The metrics and quality measures will be used by the Oregon Health Authority and the CCOs to determine whether they are effectively and adequately improving health, making quality care accessible, eliminating health disparities, and controlling costs for the populations that they serve.

"The ability to measure health outcomes is how we will ultimately drive down costs and improve health," says Tina Edlund, chief of policy for the Oregon Health Authority. "Measuring a person's health outcomes, not the number of procedures and tests they receive, is the only way to improve people's health while also lowering costs."

The challenge for this committee is determining the right metrics to use. At its second meeting, the group was presented a list of more than 50 potential quality measures relating to access, quality and cost. The list included metrics such as alcohol misuse screenings, avoidable emergency department visits, how often a patient's doctors are communicating with each other, immunization levels, and follow-up appointments after hospitalizations for mental illness. Another potential metric involved the amount of money each CCO spends on preventive and outcomes-based care coordination versus how much it spends on traditional fee-for-service care.

For each of the measures, committee members grappled with tough questions. First, a metric has to be achievable: are the underlying data readily available to test whether we are hitting our goals? Second, if we are able to collect data, will improving on a given metric actually lead to better health, better care, and lower costs?

The metrics that are selected could be measured either against absolute benchmarks, or against gradual improvements, or both. Many of the metrics, including some of the core metrics, will be tied to performance payments — beginning in July of next year, part of CCOs' reimbursement and their global budgets will be based on their performance on these metrics.

By the end of October the committee will deliver its metrics and scoring plan to the Centers for Medicare and Medicaid Services for its approval. The next meeting is scheduled for Sept. 25.

For more information about the Metrics and Scoring Committee: www.oregon.gov/oha/pages/metrix.aspx.